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Case Reports
. 2016 Feb 17;6(1):30519.
doi: 10.3402/jchimp.v6.30519. eCollection 2016.

A combination of intramural stomach and portal venous air: conservative treatment

Prabin Sharma  1 , Elias George Akl  2
Affiliations
Case Reports

A combination of intramural stomach and portal venous air: conservative treatment

Prabin Sharma et al. J Community Hosp Intern Med Perspect. .

Abstract

Emphysematous gastritis is a severe and rare form of gastritis with characteristic findings of intramural gas in the stomach. It is an acute life-threatening condition resulting from gas-producing microorganisms invading the stomach wall. Early diagnosis and initiation of treatment with bowel rest, hydration, and intravenous broad-spectrum antibiotics is imperative for an effective outcome. Surgical intervention is reserved for perforations, peritonitis, strictures, and uncontrolled disseminated sepsis. We present a case of an 82-year-old female with prior history of colon and uterine cancer on remission treated with surgeries who presented with bilious vomiting, abdominal discomfort, and nausea. She was tachycardic and had a diffusely tender abdomen with rebound on examination. Her laboratory results including blood count, serum chemistry, and coagulation studies were normal. She was diagnosed with emphysematous gastritis based on the characteristic radiographic findings of intramural stomach gas and also the presence of gas in the portal venous system. It is important to differentiate emphysematous gastritis from gastric emphysema because of the difference in management and prognosis, as emphysematous gastritis has a worse outcome and requires aggressive management. Despite an anticipated poor prognosis due to the known grave outcomes of emphysematous gastritis, our patient was successfully managed with conservative treatment. We concluded that she developed emphysematous gastritis probably secondary to immunosuppression and possible mucosal tears from multiple bouts of vomiting. She had a stable hospital course and resolution with medical management most likely due to early diagnosis and initiation of appropriate treatment.

Keywords: gastric emphysema; gastritis; portal venous air; stomach wall air.

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Figures

Fig. 1
Fig. 1
CT abdomen showing intramural air (yellow arrow) within the proximal–mid stomach consistent with emphysematous gastritis.
Fig. 2
Fig. 2
CT abdomen/coronal view showing intramural air (yellow arrow) within the proximal–mid stomach consistent with emphysematous gastritis.
Fig. 3
Fig. 3
CT abdomen/coronal view showing portal venous air (yellow arrow) within the left lobe of the liver.
Fig. 4
Fig. 4
CT abdomen showing portal venous air (yellow arrow) within the left lobe of the liver.
See this image and copyright information in PMC

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